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Federal forms, ICRs, and supporting documents

Information Collection

Certification Of Eligibility To Receive The Fehbp Premium Rebate Under The Medicare Catastrophic Coverage Act

IC 157050 under ICR 198809-3206-002 · OMB 3206-0181.

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Information Collection (IC) Details

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CERTIFICATION OF ELIGIBILITY TO RECEIVE THE FEHBP PREMIUM REBATE UNDER THE MEDICARE CATASTROPHIC COVERAGE ACT
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form RI 79-14 No No


    

900,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 900,000 0 900,000 0 0 0
Annual IC Time Burden (Hours) 450,000 0 450,000 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
 
 
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.